Feline Board Review

By Karen Adams,2014-08-12 09:58
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Feline Board Review ...

Feline Board Review Ovariohistorectomy The body of the uterus is more caudal and difficult to exteriorize, therefore make the incision in the middle third of the caudal abdomen Suspensory ligament attaches the ovary to the kidney; the broad ligament attaches to the uterine horn and ovary Antesthesia and analgesia Periodontal dz See canine GI parasitism Toxacara cati, leoni feline roundworm Ancylostoma tubaeforma feline hookworm Aelurostrongylus abstrusus lungworm of cats Ollulanus tricuspus stomach worm of cats Dipylidium caninum tapeworms of dogs and cats Spirometra mansinoides tapeworm Platynosomum concinnum feline bile and pancreatic duct worm; infected thourhg ingestion of infected lizards Isospora felis and rivolta coccidian of cats Toxoplasma gondii oocyst Sarcocystis Ear mites Otodectes cynotis Most common otic parasite and responsible for 50% of otitis externa in the cat (only 5-10% in the dog) Many cats acquire an immune response that prevents further infestation Predisposing factors: a. Poor conformation narrow ear canal, hair, floppy, heavy ears b. Obstruction of canal from acute inflammation or tumor c. Systemic dzs Felv, FIV can predispose to otitis externa Signs: a. Pruritis is common sign head shaking, periauricular self-trauma w/ excoriation, alopecia, rubbing the side of head b. Painful ear c. Discharge or foul odor d. Erythema of pinna and vertical canal e. Erosions and ulceration of the ear - Gram negative bacterial infections or contact dermatitis Dx Cytology of ear canal Assess the state of tympanic membrane lack of membrane may indicate middle ear dz, but normal tympanic membrane does not rule out middle ear dz Best tx for cats is Revolution, Mitaclear, Acarexx or milbemycin oxime Otitis externa Causes: 1. Demodex, Sarcoptes, Notoedres, Eutrombicula alfreddugesi 2. Foreign bodies, Plant material (grass awns, foxtails), dirt, debris, dried medication, displaced hair 3. Atopy 4. Food allergy 5. Contact allergy 6. Keratinization disorders seborrhea most common, fatty acids irritating to the ear canal (also male feminizing syndrome, male feminizing syndrome, Sertoli or interstitial cell tumors and ovarian imbalances) and hypothyroidism in dogs 7. Pemphigus folliaceus, pemphigus erythematosus, cutaneous lupus, SLE, Pemphigus vulgairs, Bullous pemphigoid and drug eruptions 8. Neoplasia inflammatory polyps 9. Zn responsive dermatosis 10. Juvenile cellulites (puppy strangles), Lethal acrodermatitis of bull terriers 11. Chronic wet ears or improper drying after cleaning 12. Systemic dzs Felv, FIV, CPV, CDV, hyperadrenocortism, diabetes mellitus 13. Bacteria Staph intermedius, Staph epidermidis, Strept, Pseudomonas, Proteus, E coli 14. Fungal Malassezia most common Tx - Ear cleaning and hair plucking - Ceruminolytic agents - Drying - Topical therapy for Yeast is Conofite or Tresaderm, for Bacteria is Gentamycin (oto-toxic) or Enrofloxacin and Silver sulfadiazine (Baytril otic) which is not as oto-toxic - Systemic therapy may be necessary if complicated by otitis media Abscesses Aerobic Pasteurella multocida, beta hemolytic strept, Bacteroides, Fusiform bacilli, Actinomyces Anaerobic Clostridium, Bacteroides, Peptostreptococci, Enterobacteria Bacteria inoculated under skin via bite wound, then wound surface seals and creates a local decrease in oxygen tension which may predispose to anaerobic infections abscess usually forms w/in 2-4 days after injury Signs: a. ADR, fever b. Tissue edema, sicoloration of overlying skin c. May rupture and drain purulent material

d. Anaerobic cellulites skin will be friable, darkly discolored and necrotic; area of infection is poorly defined Tx a. Sx debride and remove necrotic tissue b. Provide drainage c. Use whirlpool therapy or wet dressings to improve drainage, increase circulation, and promote healing of both open and closed lesions d. Abs Clostridium high dose penicillin e. Anaerobic therapy Clindamycin, amoxicillin, Chloramphenicol, Metronizadozole f. Aerobic therapy Amoxicillin, Oxacillin, Cephalexin g. Nutritional intake to promote positive nitrogen balance h. Antipyretics for fever Upper respiratory system virus and Chlamydia Several causative agents a. Feline rhinotracheitis virus herpes b. Feline calicivirus c. Chlamydia psittaci d. Bordetella bronchiseptica e. Mycoplasma Rhino and calicivirus account for 85-90%of the feline upper respiratory infection complex Transmission via direct contact between susceptible cats and infected cats or contact w/ contaminated fomites virus can travel maximum of 4 feet Most cats develop a carrier state after acute natural infection w/ feline rhino, calicivirus and chlamidia Signs; a. Fever, ADR b. Serous to mucopurulent oculonasal discharge c. Reluctance to eat, oropharyngeal vesicles/ulcers, hypersalivation are often present d. Dehydration and wt loss e. Ocular dz with or without resp signs Dx is usually based on history and clinical signs and ID of specific agent is difficult Tx a. Supportive care is most important aspect b. Cats capable of eating and maintaining normal hydration are best tx on an outpatient basis c. Keep eyes and nares free of discharge d. Humidify the upper airway w/ a steam or cold mist vaporizor or confinement to a bathroom w/ a shower running e. Warm, well ventilated well lighted environment and good nutritional support f. Hospitalization in cats w/ hypersalivation caused by oropharyngeal vesicles or ulcers fluid tx and assisted feeding g. Abs for secondary bacterial infections Ampicillin, Amoxi, Doxycycline, Chloramphenicol Vaccination Rhino and Calici virus only; Chlamidia is not recommended b/c of low incidence in single cat households (can be used in catteries and research facilities) Flea bite dermatitis (FAD) Allergic reaction to bites inflicted by Ctenocephalides felis, Ctenocephalides canis, or Pulex irritans Caused by hypersensitivity to allergens and haptens in flea saliva Type I IgE Type IV cell mediated immunity Late onset IgE Cutaneous basophil hypersensitivity Only immediate hypersensitivity has been reported in the cat (can have immediate and delayed in the dog) Signs 1. lesions over posterior one third of body 2. Miliary dermatitis on head and neck of cats 3. Eosinophilic granuloma complex of cats 4. Pruritis 5. Papulocrustous eruptions 6. Secondary alopecia, exoriations, pyoderma Dx above signs and presence of fleas or flea dirt, fecal exam postive for Dipylidium (tapeworm) Tx a. Flea control sprays for house, Insect Development Inhibitor (Lufenuron/Program), Frontline topical b. For pruritis, give Pred in decreasing doses then stop or continue at lowest effective dose c. Abs and antibacterial shampoos d. Hyposensitization is controversial and rarely effective e. Strict flea eradication is ONLY effective tx for FAD Conjunctivits Inflammation of ocular MM „Red Eye‟ Many causes: a. Bacteria Gram positive cocci, coliforms, mycoplasma b. Chlamydia psittici c. Viruses Rhino, Calicivirus d. Foreign body plant material most common e. Parasites Thelazia, Cuterebra, Dirofilaria f. Immune mediated causes allergies, plasma cell, eosinophilic conjunctivitis g. Irritancts topical meds, dust, plants, pollen h. Eyelid dz trichiasis, distichiasis, ectopic cilia, eyelid masses, tumors, chalazia i. Inadequate eyelid closure ectropion, macropalpebral fissue w/ lagophthalmus, facial nerve paralysis, proptosis, loss of sensory innervation (CNV) j. KCS

Insults can induce vasodilation and neutrophilic/lymphocytic infiltrates long term insult induces squamous metaplasia of epithelium, loss of conjunctival goblet cells, lymphocytic/plasmacytic infiltrates and lymphoid follicle formation Signs: a. Hyperemia of conjunctival vessels (not deeper episcleral vessels) b. Ocular discharge serous, mucoid, mucopurulent, hemorrhagic, or combo c. Chemosis d. Discomfort squinting, photophobia e. Proliferative lesions granulmas, tumors w/ local inflammation, multifocal or generalized proliferative lesions Dx Schirmers tear and fluroescein stain; obtain samples before stain use Use metal spatula , after topical anesthesia, several scrapes in same direction until small droplet of material is collected; prepare minimum of three slides DDx sclertis, uveitis, glaucoma, keratitis Tx 1. primary dz when identified 2. Remove irritants and foreign bodies or sx correct eyelid disorders 3. Antiinflammatories 4. Remove discharge clip periocular hairs and use moistened cotton to soak and remove exudates, use eyewash solution or sterile saline to clean ocular surface 5. Antihistamines Antzoline (H1 antagonist) or Naphazoline (sympathomimetic) 6. NSAIDs Flurbiprofen, Suprofen, Diclofenac, Detorolac, for acute allergic chemosis 7. Flunixin meglumine 8. Aspirin 9. Not to be used in animals w/ abnormalities or renal dz 10. Cyclosporin (Optimmune) improves health of cornea and conjunctiva for KCS 11. Steroids are contraindicated in primary infectious conjunctivits or when corneal ulcer is present **Topical corticosteroids or NSAIDs should be used w/ caution in cats w/ conjunctivitis b/c concerns about recrudescent feline herpesvirus Cystitis Can be bacterial, Fungal or idiopathic Can be 1. Uncomplicated (simple) acute, no abnormalities identified; usually self-limiting, prognosis is good 2. Complicated predisposing cause is identified 3. Recurrent returns after withdrawal of therapy; Relapse of original bacteria or reinfection by a different pathogen Bacteria Frequently isolated E coli, Staph intermedius, Strep, Proteus, Klebsiella or Pseudomonas Fungus isolated Torulopsis, Candida, Cryptococcus, Blastomyces, Aspergillus Ascending through the urethra is most common (but can also be descending or lymphatic in origin) Predisposing factors include steroid tx, catheterization, sx alteration, uroliths, or outflow obstruction Can induce pyelonephritis, prostatitis, septicemia, struvites, granulomatous urethrocystitis, polyps, urinary incontinence or emphysematous cystitis Signs: 1. Pollakiuria frequent voiding of small amounts of urine 2. Dysuria 3. Stranguria 4. Hematuria Dx Bacteriuria may not be detected in some cases (must be over 10^5 per mL to be detected in urine sediment) Urine culture and sensitivity prior to Ab therapy Tx 1. Uncomplicated Abs based on Gram staining properties (Gram + penicillins, Clavamox, Gram Fluroquinolones or sulfonamides) for 7-14 days 2. Complicated Correct any underlying defect; tx w/ appropriate Ab for 7-14 days 3. First time relapsing UTI 4-6 weeks of Ab 4. Subsequent relapsing UTI 6-8 weeks 5. Reinfection tx for 7-14 days following remission of clinical signs; continue for another 3-6 months at 1/3 the daily dose after the animal‟s last voiding of the day (bedtime) 6. Fungal Flucytosine b/c it achieves high concentrations in urine Culture urine 3-5 days after initiation of Ab via cystocentesis to ensure proper Ab selection Culture again 3-5 days after the drug is discontinued Culture again before reducing dosage and then once a month at reduced dosage Culture every 3-6 months to monitor recurrent infections Monitor pts that may have altered natural host defenses for development of UTI persistent catheterization, steroid use, chemotherapy, diabetes mellitus, perineal urethrostomies FLUTD AKA Feline urologic syndrome, Idiopathic lower urinary tract dz, Intersitisal cystitis Idiopathic hematuria and dysuria in cats w/ith or without obstruction are common lower urinary tract problems in cats Cause is often not identified Feline Lower Urinary Tract Dz Causes ; Idiopathic 55% ; Uroliths 22% ; UTI bacterial or viral - < 2% ; Atypical UTI fungal, Mycoplasma, Ureaplasma, parasitic ; Trauma ; Urthral stricture ; Inflammation ; Neoplasia

; Neurogenic disorders What are the recent trends in feline urotlithiasis 1. Decreased struvide stones 2. Reduced frequency of recurrent urethral obstruction needing urethrostomies 3. Persistent inflammatory idiopathic dz regardless of dietary management 4. Increase in Ca oxalate stones What is the possible viral cause of FLUT 1. Feline syncytia-forming virus (FeSFV) not been proven 2. Feline Herpes virus experimental only 3. Feline calicivirus perhaps due to calicivirus-like particles in urethral plugs How common is bacteria as the cause of stones RARE as the primary cause especially in younger cats In older cats, bacterial UTI is more likely, especially in renal failure cats up to 25% Secondary causes: 1. Catheter placement 2. Steroid administration What human dz is FLUTD simialar Intersititial cystitis Similarities: 1. Unknown etiology 2. Sterile urine 3. Hemorrhagic lesions visible on cystoscopy 4. Some microscopic changes in bladder mucosa 5. Increase mast cells in bladder 6. Decreased urinary GAGs Differences: 1. Persisitent, chronic infection in humans 2. Not usually associated w/ hematureia in women Clinical signs of FLUTD - Stranguria - Hematuria - Pollakiuria - Small, empty bladder (is full in obstructed cats) - U/A has blood and is concentrated - Signs resovle in 5-7 days - Male give fluids - Recurrent episodes will in frequency and severity over time Signalment - Young, adult cats 2- 6 years - Males and females equally - But males are more likely to become obstructed w/ muco-crystalline plugs - Neutered cats of both sexes seem to be at increased risk Factors Environmental - Sedentary, obese, indoor cats at increased risk - Water intake, urine volume and litter box habits - Increased incidence in winter expecially w/ outdoor cats - Dirty litter box Diet - Dry cat food increases the risk 1. Mg 2. Reduced caloric density 3. Reduced digestiblity 4. Increased fecal volume 5. Increased urine concentration - Ad lib v. controlled feeding ad lib feeding causes more sustained alkaline tide, but is usually less than cat fed once or twice a day. Stuvite crystal are less soluble in alkaline pH. - GAGs in uroepithelium Stress - Increased incidence following the California earthquake - Holidays - Rapid weather changes - Changes in household members - Anxious cats - mast cell and histamine release Anatomy

- Vescicourachal remnant or diverticuli may cause incomplete emptying of the bladder Tx of FLUTD Nothing - Most recover is 5-7 days regardless of treatment - SQ fluids to males to avoid blockage Abs - Do NOT appear to work since bacteria is rarely the cause Corticosteroids - Contraindicated in cats w/ bacterial UIT or indwelling catheters - Reserve steroids for: a. Obstruced cats w/ traumatic catheterization b. Refractory non-bacterial LUTD w/ unhappy client Minimize stress - Amitryptyline (Elavil) Anti-anxiety drug that also is a a mild analgesic, sedative, antihistaminic & anticholinergic - Adverse effects include liver enzymes, wt gain, poor hair coat and urine retention - Phenoxybenzamine - urethral spasms and therefore decrease pain - Butorphanol for pain - Diazepam for stress - Keep litter box assessible - Offer fresh, clean water may need to drip from faucet Diet - Canned food - Flavored water - Avoid fish - Avoid food high in ash & mineral - May add salt - C/D s makes urine more acidic GAGs - Pentosan polysulfate is a synthetic polysaccharide that mimics or replaces GAG layer coating the bladder a. helps prevent adherence of bacteria, crystals or proteins to bladder epithelia b. limits the mucosal permeability to noxious substances in urine Antispasmodic agents - Symptomatic relief of pollakiruia, dysuria & stranguria - Anticholinergic (Oxybutynin, not propantheline) may decrease the frequency of urination - Alpha antagonists (Phenoxybenzamine, Prazosin) may minimize resisitance in pre-prostatic and prostatic urethra, hypotension is primary adverse effect - Dantolene or diazepam skeletal muscle relaxants Analgesics - Butorphanol good w/ acute flare-ups - NSAIDs (ketoprofen) Intravesicular tx - Flushing bladder w/ cool saline or DMSO sitmulate degranulation of mast cells and may „exhaust and flush‟ sensory neuropeptides & inflammatory mediators Things to avoid - Phenopyridine - Methylene blud - Urinary acidifiers - Abs Feline behavior Most common complaint is inappropriate or elimination Causes: - Underlying dz can include FLUTD, renal dz, metabolic disorders, anatomic abnormalities, or orthopedic conditions - Aversions to litter type or litter box - Location of litter box heavy traffic areas, aversive event in the area of litter box - Stress marking, new people in house “Spraying” is urine on a verticle surface and will have a classic upright tail quiver a the time of urine spray; this is a form of feline communication Non-spraying is marking on horizontal surface Tx clean soiled areas w/ enzymatic products, offer multiple boxes, different locations, vary litter depth, keep box clean, avoid scented litters and cleaning products, use positive reinforcement for appropriate litter use, give cat set play and attention times at least 20 minutes a day, antianxiety meds (Amitriptyline, Diazempam, Buspirone, Clomipramine, Megestrol acetate), neuter intact animals, interrupt inappropriate elimnation by startling the cat (foghorn, whistles) in first 30 seconds Other behavior problems: - Aggression second most common

- Obsessive compulsive disorder grooming, consumptive, hallucinatory - Attension seeking - Scratching - Destruction - Vocalization - Overactivity Onychectomy Declaw blade, nail trimmers, or CO2 laser Pre and post op pain meds (Torb, Butor) and local anesthesia considerations Can glue, suture, or bandage only for closure Tendonectomy Tendonectomy of Deep digital flexor prevents retraction of P3 Claw remains in retracted position b/c of the dorsal elastic ligament Nails need to be trimmed every 3-4 weeks b/c will continue to grow Dental Neck Lesions AKA feline odontoclastic resorptive lesions (FORL), cervical line lesions, feline caries Pathophysiology is abnormal odontoclast activity Lesions appear as cavities in the teeth at or near the cemento-enamel junction arising from the gingival margin (gumline) Cavities are lined w/ odontoclasts which are constantly resorpting dental material by degrading dentine by decalcification causing a resorptive lacunae The normal function of odontoclasts is to remove the roots of deciduous teeth as the permanent teeth erupt and hence the deciduous crown is lost these cells become reactivated by some stimulus - so it eats a hole in the tooth The process exposes the dentinal tubules which is extremely painful and granulation tissue proliferates from the gum over the lesion FORL invades the enamel or cementum and even the pulp the root can separate from the crown and the crown will be lost (probe thorugh the area where a root should be) Only one effective tx extraction Toxocariasis Toxicara cati Feline ascarid Feline roundworm Small intestine of cats 3 routes of transmission: Direct tracheal migration Ingestion of parantenic host somatic migration in parantenic host Lactogenic (transmammary) no migration Toxacaris leonina Ascarid of both cats and dogs Small intestine of both cats and dogs in the US Eggs are oval with smooth shell. NO MIGRATION OCCURS Ulcerative keratitis (corneal ulcers) Three depths: - Superficial erosion (corneal epithelium only) - Stromal ulcer both epithelium and some stroma - Descemetocele stroma down to Descemet‟s membrane Causes: a. Trauma scratch, foreign body, b. Eyelid dz distichiasis, ectopic cilia, entropion c. Tear film dz KCS, goblet cell deficiency d. Infection fungal, bacterial, Feline Herpesvirus (may be primary or may be from recurrence of latent infection) e. Detergent agents, acids, alkaline agents f. Immune-mediated marginal kerattitis Will see signs of upper respiratory infection and ocular discharge associated w/ Herpesvirus keratitis in kittens Most primary FHV are seen in young cats and are associated w/ upper resp dz Latency is a condition in which the virus does not cause clinical signs of dz but continues to exist in trigeminal ganglia and perhaps corneal cells When virus is reactivated by stress or topical steroids, signs of upper resp infection are usually absent Arthritis Causes: 1. Feline Syncytium-forming Virus (FeSFV) progressive polyarthritis; most also have FelV or FIV; results from chronic antigenic stimulation and immune complex deposition 2. Degenerative joint dz 3. Infectious polyarthrits calcivirus, mycoplasmosis 4. Erosive polyarthritis (Feline chronic progressive polyarthritis) immune mediated; males 1-5 years; deposition of immune complexes in the joint; serology test for Rheumatoid factor (RF) is positive and NEGATIVE for Antinuclear Antibody (ANA) 5. Nonerosive Polyarthritis systemic lupus erthematosus (SLE) most common, has been associated w/ diskospondylitis, enteropathy, bacterial endocardiits, and drugs; Type III hypersensitivity reaction formation and deposition of immune complexes and autoantibody formation (dx via LE cells; positive for ANA and negative for RF 6. Other lamenesses as in dogs Cranial crutiate rupture, joint luxation

Trichobezoar Hairball Tx w/ brushing your cat and petroleum or other hairball products Feline Acne Follicular problem most common on the chin Recommend owner to change feed bowls to stainless steel Cytology, DTM or biopsy to r/o yeast dermatitis, demodex/furunculosis (Demodex cati, gatoi canis), dermatophytes Tx is Abs (Enrofloxacin, Cephalexin, Tetracycline), Retin A, topical shampoos, Listerine, malacetic wet wipes Inflammatory Bowel Dz Signs vomiting, anorexia, large or small animal D+, enterocolitis Remember that Feline panleukopenia (feline distemper, feline parvovirus) induces an infectious enteritis and mesenteric lymphadeopathy Eosinophilic enteritis etiology unknown, may be induced by parasite migration or food or bacterial antigen sensitivity; ddx needs multiple biopsy Lymphocytic-plasmacytic enteritis ddx needs biopsy Hyperesosinophilic syndrome of cats eosinophilic infiltrates in multiple organs; mature eosinophils differentiates from neoplasia Granulomatous enteritis Food Allergy/Hypersensitivity Type I hypersensitivity within minutes to hours after ingestion or Type IV hypersensitivty delayed w/in hours to days of ingestion FISH is an offending allergen in 50% of cats w/ food allergy Can also be food contaminants (bacteria, toxins, additive, fungal) Other allergens include: beef, pork, chicken, cow‟s milk, horse meat, eggs, wheat, oats, fish, whale meat, soy products No age, breeds or sex predilections Signs in cats; 1. Generalized pruritis (most common signs in dogs) 2. Miliary dermatitis 3. Facial and head pruritis 4. Pruritic angioeema-urticaria 5. Eosinophlic plaque/ulcers 6. Erythema 7. Has been manifested as lymphocytic plasmacytic colitis in cats Dx: 1. Nonseasonal occasion of signs 2. Lack of response to steroids or other anti-inflammatories 3. Lack of response to progestational drugs in cats 4. No specific test other than hypoallergenic test diet place animal on a very limited number of foodstuffs that are free of colorings, preservatives and flavoring (1:1 lamb and rice homemade diet) 5. Avoid flavored heartworm or other types of medications that could be flavored or contain preservatives 6. Once improvement is noted, challenge the animal w/ original diet to substantiate the dx relapse should occur w/in 72 hours but may take as long as 10 days Tx Pred may be used for severe pruritis; When maximum improvement is noted on the test diet, switch to lambe based or other less expensive, less time consuming diet; made need supplements Heart failure - Feline Cardiomyopathy HCM most common DCM caused by decrease in taurine, ask about the diet to r/o Restrictive –„intermediate‟, virus induced, fibrosis, heart is stiff Need echo to ddx Hypertrophic Cardiomyopathy Signs Middle aged, male cats Pleural effusion (right sided heart failure) Tachycardia Anorexia Dyspnea Heart murmurs Hypothermia Gallop thyrthm or other arrhythmias MM are pale and muddy Easily stressed and fragile Thrombosis blood can clot, turbulent flow causing paralysis of rear legs RULE OUT HYPERTHYROIDISM IN THESE CATS Dx 1. ECHO a. Very thick papillary muscles b. Biatrial enlargement „Valentine shaped heart‟ c. Endocardial fibrosis d. Left outflow obstruction e. SAMMS HOCM seen w/ thick, venticular contraction

Tx 1. This is a diastolic dysfunction, need the heart to relax to have to fill. Do NOT put on an ionotrope (Dig). Need to slow down w/ ; blockers or Ca channel blockers 2. May need to put in oxygen-rich cage to rest 3. Nitro patch and Lasix to help stabilize 4. ; blockers or Ca blockers to help slow the heart down (don‟t use at same time) a. Atenolol - ; b. Diltiazem - Ca c. Enalapril ACE inhibitor d. Aspirin prevents thromoembolism Remember to check for underlying hyperthyroidism Intersitial Nephritis (all spp) Causes: 1. Hematogenous 2. Infectious most common, septicemia or bacteremia; may cause lesions themselves but not interstitium a. Leptospirosis pomona in cattle and pigs, canicola & icterohemorrhagica in dogs b. E. coli white spotted kidney dz in calves c. EIA 3. Immunologic Type II hypersensitivity rxn to viral antigen in tubule epithelial cells; less common a. Infectious canine hepatitis localizes in tubules after intial uremia Subacute response. For example, Lepto causes bacteremia, bacteria migrate out of vessels into lumen of tubules and replicate; reinfect epithelial cells and cause lymphocytic plasmacytic inflammation to antigens of lepto. Antiges die in tubular epithelial cells Lesions may be diffuse or multifocal depending on agent. Grossly acute to subacute pale, swollen, scattered white foci on capsular surface; white-gray raidal streaks or foci in the cortex and medulla Chronic renal fibrosis Acute interstitial edema; leukocyte infiltration, focal tubular necrosis Subacute mononuclear cells (lymphoplasmacytic) infiltrate Hyperthyroidism in cats Thyroid Hypo TRH Pituitary TSH T4 Thyroid Description Excessive production and secretion of thyroixine (T4) and trilodothyronine (T3) ***All older cats w/ suspected cardiomyopathy should be evaluated for hyperthyroidism aka Graves dz & diffuse toxic goiter in humans Cause Multinodular adenomatous hyperplasia Rarely caused by adenoma or carcinoma Signalment Older cats in Europe & North America Clinical Signs Not all signs seen in all cats Acute or gradual onset of clinical signs Can often palpate a thyroid mass Wt loss w/ polyphagia Hyperactivity/nervousness V+/D+ Unkempt appearrance/hair loss Tachycardia & heart murmur Anorexia/apathy DDx for Hyperthyroidism Primary cardiomyopathy Renal dz GI dz (Malabsorption syndromes, Pancreatic insufficiency) Liver dz Cancer cachexia Cushings DM

Lab findings Alk phos Hyperphosphatemia PCV Normal SG despite PU/PD Mild increase in glucose (not DM range) Radiographic findings Cardiomegally most obvious on lateral view CHF sings contrast of abdominal organs due to loss of muscle mass and fat b/c of wt loss ECG Sinus tachycardia (> 240 bpm) R wave (ventricular concentric hypertrophy) Atrial premature complexes Other changes also possible but occur less frequently Anesthetic risk Dx Serum T4/T3 but will flucuate a lot, and T3 is usually elevated anyway T3 suppression test TSH stimulation Thyroid scan Tx Surgery Can be done by average practitioner Patients are an increased anesthetic risk Iatrogenic hypoparathyroidism (accidently take out parathyroid) Hyperthyroidism can reoccur take out capsule, too and leave 1 of the parathyroids Post sx complication: a. Sudden death b. Hypocalcemic especially if bilateral thyroidectomy and get parathyroid c. Relapse if capsule not removed Antithyroid Drugs Not cytotoxic but block thyroid hormone synthesis a. Tapazole - Methimazole; 15 mg divided TID b. Propylthioouracil (PTU) 150 mg divided TID a. Anorexia and V+ are potential side effects (esp PTU) b. OK for perioperative mgmt but less desirable for long term treatment c. Atenolol/Propanolol - ; blocker for cardiac mgmt Radioactive Iodine Easiest and safest way to treat hyperthyroidism, but cost up to $1200-1400 T4s often WNL by 1 week If not, then a carcinoma Need for retreatment uncommon unless patient has thyroid carcinoma Requires special license and facilities for handling radioactive waste May not want to use in cats w/ concurrent renal dz Bladder stones (cystic calculi) Much more common in dogs than in cats Struvite (Mg ammonium) are most common type in both spp Causes: 1. Increased amt of mineral in the urine 2. Increase urine concentration 3. Urine pH 4. UTIs w/ urease producing bacteria (Staph, Proeus, Ureaplasma) can cuase struvites by increasing the amount of ammonium ions and alkalinizing the urine Present w/ lower urinary tract inflammation signs Dx is via palpation, U/A, rads, U/S Quantitative stone analysis and bacterial culture needed for therapy and prevention If analysis not obtained, then base on the following: 1. Hypercalcemia or acidosis Ca oxalate or Ca phosphate calculi 2. Struvite usually form in alkaline urine 3. Ammonium urate and Silica in neutral to acid urine 4. Cystine calculi in acid urine 5. Ca oxalate in any pH 6. Struvite are often associated w/ UTIs Tx: See under kidney function test paper in other notes

The blocked cat Most common emergency seen in male cats!!! Clinical signs ; Tip of penis may be discolored ; Mucous plug may need massage to unblock ; Restless ; Crying ; Stranguria ; Painful abdomen ; Avoid rupture don‟t palpate too hard ; May be in stuperous or comatose state ; Seems „constipated‟ – strains, but nothing comes out Diagnosis Stat Bloodwork (iSTAT) ; PCV & TP ; Glucose ; ??? BUN post renal azotemia ; Electrolytes Hyperkalemia causing life-threatening arrhythmias due to automaticity of SA node ; Blood gases metabolic acidosis ; Ionized Ca hypocalcemia w/o clinical signs b/c phosphorus is so high, so Ca shifts down Treatment emergency blockage Step I take care of the heart ; Place IV catheter ; Get blood to monitor K+ ; IV fluids w/ Lactated Ringers or Normasol R both have a little K+ ; In severe hyperkalemia, use 0.45% NaCl w/ 2.5% Dextrose w/ 1 mEq/kg of NaHCO3 ; Shock and bolus of 30 mL/kg fluid Hyperkalemia tx three choices in this order ; Regular insulin + dextrose IV 0.1 unit/lb of regular insulin w/ 0.5 g/kg of 10% dextrose ; Add 5% dextrose to IV fluids to shifts K+ into the cell ; Give 0.5-1.5 mL/kg of 10% Ca gluconate IV slowly to protect the heart ; Give 1-2 mEq/kg of NaHCO3 IV slowly shifts active, ionized Ca down, so use last when nothing else works ; May need all three txs Step II need for anesthesia ; Only if nt comatose or severely depressed is anesthesia needed ; Ketamine (2.5-5 mg) + valium (1-1.5 mg) IV ; Also oxymorphone + valium, isoflorane, propofol, thiopental Step III - Relieve obstruction ; Wash hands ; Use Tom cat catheter w/ open end and lubricated ; Pull scrotum caudally to straighten out to pass catheter through sigmoid flexure ; Don‟t force, be gentle ; If stone, flush gently to push back into bladder w/ sterile saline ; Can also use 3.5 red catheter (not hard Tom cat plastic) but doesn‟t have open end so use AFTER unblocked ; If blockage won‟t pass, do cystocentesis to empty w/ just just one stick – use stop cock for continual removal ; Dex + lidocaine to flush to reduce urethral spasms Step IV flush bladder and attach closed drainage system ; Prevent reobstruction ; Match ins & outs ; If mucus plug w/ not azotemia may not need catheter ; Put on fluids otherwise ; Leave some saline (acid pH) in the bladder if suspect struvite crystals ; Flush catheter as remvoing tom cat catheter and replace w/ red catheter ; Don‟t leave open to the air ; Leave in place until urine is clear and cat is no longer azotemic ; E collar Step V monitor, monitor, monitor ; Hypokalemia develops due to solute diuresis; keep on fluids and monitor ins and outs ; Monitor Na, K, Ca, P, BUN, CREA, PCV & TP ; Add 20 mEq KCl to each liter after K levels return to normal ; Must taper off fluids to prevent medullary washout ; Reduce by a half throughout the day, may send home w/ SQ fluids ; Warn owner for early detection of re-obstruction

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